Provider Demographics
NPI:1225120538
Name:CRENSHAW, JOANNE (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47568 ANCHORAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-4712
Mailing Address - Country:US
Mailing Address - Phone:703-421-2875
Mailing Address - Fax:703-421-5701
Practice Address - Street 1:21135 WHITFIELD PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7279
Practice Address - Country:US
Practice Address - Phone:703-766-6165
Practice Address - Fax:703-444-4985
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057318207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010021880Medicaid
VAG54645Medicare UPIN
VA010021880Medicaid